Primary Camp Registration

July 3 – 6, 2021

Campers entering grades 4 & 5

Arrival time: Saturday, 1:00 – 2:30 pm

Departure time: Tuesday, 6:00 – 7:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Primary Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

Beginner Camp Registration

July 7 – 10, 2021

Campers entering grades 3 & 4

Arrival time: Wednesday, 3:00 – 4:30 pm

Departure time: Saturday, 1:00 – 2:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Beginner Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

Senior High Camp Registration

June 12 – 15, 2021

Campers entering grades 10, 11, 12 & Graduating Seniors

Arrival time: Saturday, 1:00 – 2:30 pm

Departure time: Tuesday, 6:00 – 7:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Senior High Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

Junior High Camp Registration

June 19 – 22, 2021

Campers entering grades 8 & 9

Arrival time: Saturday, 1:00 – 2:30 pm

Departure time: Tuesday, 6:00 – 7:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Junior High Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

Intermediate Camp

June 26 – 29, 2021

Campers entering grades 6 & 7

Arrival time: Saturday, 1:00 – 2:30 pm

Departure time: Tuesday, 6:00 – 7:00 pm

Step 1 of 4 - SELECT GENDER

SELECT GENDER
Gender*
- Boy
- Girl

CAMPER INFORMATION
Camper Name*
First Last
Address*
Address City State ZIP Code
Date of Birth*
School grade entering in fall*
Cabin Mate Request
Choice 1
Choice 2
HEALTH INFORMATION
Physician’s Name*
Physician’s Phone Number*

PARENT INFORMATION
Parent Name*
First Last
Primary Phone*
Secondary Phone
Email*
CHURCH INFORMATION
Local Church Name*
Pastor’s Name
Church Phone
Church mailing address*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Phone Number*
Relationship to Camper*

Pay
Intermediate Camp Fee
Price: $140.00
Pay Deposit or Pay Full
- Pay Full
- Pay Deposit
Remaining Balance Due
Price: $0.00
non-refundable registration fee.
Total Due Today
$0.00
Credit Card*
Card Details
Cardholder Name

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